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Q: How long does a facelift last?


A: The benefit of a deep-plane facelift does not wear off the day after the warranty expires, like a home appliance. The facial tissues have been repositioned the way they were before the effects of aging and gravity took hold. In doing so, many of the signs of aging are reversed. Of course, we cannot slow the aging process itself. With time, the skin will gradually loosen and the tissue will gradually settle with gravity. New wrinkles will appear as the muscles continue to contract the overlying skin, forming creases. In other words, “time marches on.” This reality is well-understood by most patients, who actually find it comforting; they do not want to look the same the rest of their lives. The surgery “turns back the clock” on appearance.


Q: Will I need to have another facelift?


A: This is another common question, and the answer depends on patient expectations. At a future time, the tissues may relax sufficiently to warrant another facelift. Occasionally, in a patient with marked loosening of the facial tissues, jowls may persist even after a properly-performed deep-plane facelift. It is possible to repeat a facelift using the original incisions, so there are no new scars. In this situation, I may perform a more superficial “imbrication” procedure, tightening the fat layer itself. This procedure specifically targets persistent jowls.


Q: I’m nervous about having a facelift. What else can I do instead?


A: There is no substitute. Alternatives such as fillers, Thermage, nonablative laser treatments, mini-lifts, and string lifts are insufficient. The problem is fallen tissue and the only way to correct this problem is by lifting it back up.


Q: Can you tighten my neck using just the incision under my chin, avoiding additional scars around my ears?


A: The submental approach is used on its own in younger patients who have extra fat under the chin but do not have much extra skin. You’d think that the extra skin could be removed with a tuck under the chin, but it just doesn’t work. The incision is too small to allow much skin removal without creating big pleats that would look bad. Surgeons have tried making larger incisions along the front of the neck to remove extra skin, but the scars are too conspicuous. It’s better to keep the scars tucked around the ears instead. The ear scars can be remarkably well-hidden if the surgeon knows the tricks to avoid telltale signs of surgery.


Q: Do you use tissue glue?


A: No. I prefer sutures. Tissue glue is derived from human plasma, so there is a theoretical risk of disease transmission, however small. There is also a bovine component to the glue, so an allergic reaction is possible. It has not been shown to reduce the risk of hematomas, and it adds significant cost without any benefit in the scar appearance. The product has more downside than upside, in my opinion.


Q: My family is not for this.


A: This is a statement I hear regularly. Usually patients are having surgery for their own reasons. They are not being put up to it by their spouses. Quite the contrary, in fact. Most of the time, husbands are just going along with it. They are usually passive—“She’s been talking about it for a long time and I suppose, if it would make her happy…” Sometimes during the discussion, there may be a reference to the cost of chrome accessories on a Harley Davidson. Of course, both parties can enjoy the result. Many husbands have told me what a difference the surgery has made psychologically. Their wives are happier and more confident. This can have positive repercussions for a marriage, particularly if the woman is starting to feel unattractive, or that she is not measuring up to younger competition. Many of my patients are women who are older than their husbands or look older. Children, of course, are reluctant. They may be nervous. They don’t necessarily think of their parent from the standpoint of attractiveness. It is not unusual for patients to inform their children after the surgery rather than worry them about it beforehand. The issue of jealousy can come up with friends who may be negative—a “sour grapes” attitude from those who might not be able to afford it. If all goes well, patients are congratulated on their appearance afterward. If there is a problem, they may hear, “I told you so.” Some husbands may be jealous, not wanting their wives to look too attractive, and obviously there are patients who want to look their best for what lies ahead, and it may be a new single life (See J.V., Age 45, Patient Photographs).


Q: Am I too old to have a facelift?


A: I have heard this question from patients in their 60s, which is amusing because this age does not seem to be very old anymore. With modern anesthesia and healthier patients, age itself is not a particularly important factor. In our studies, we found no significant correlation between age and result rating or incidence of complications. Facial rejuvenation surgery can provide a source of happiness in their lives that can help to offset the gradual decline that is aging. If we cannot be young, perhaps we can still enjoy some of the illusion of youth. Sometimes the major challenge for older patients is simply having someone around to help after surgery. They may be on their own and do not wish to impose on family members. Psychologically, it is much better for patients to have a partner after surgery, not necessarily a nurse, but someone to provide some TLC (as in “tender loving care”), drive them to their follow up appointments, and give them encouragement. Sometimes our office makes arrangements for one of our nurses to help at home after surgery, and this is well-appreciated by patients. The extra expense is worth it.


Q: Is it better to have surgery now, or wait until I’m older and need it more?


A: There is no advantage in waiting until you are older to have the surgery if you have the appropriate indications for surgery. You’re not burning any bridges or prematurely using up plastic surgery options. Obviously, you will enjoy the results sooner. Earlier surgery can help prevent deeper wrinkles that can be more difficult to smooth out later. You and your surgeon make the judgment call about whether your degree of facial tissue descent justifies a facelift now, or whether you can wait a few years and perhaps temporize with fillers.


Q: How much time off do I need?


A: To help answer this question, I show my patients early postoperative photographs such as those contained in the Patient Photographs section, so that they have some idea what to expect. Some patients resume work within 2 weeks of surgery, but 2 or 3 weeks is more typical, not because it is ideal, but because it is impractical for most working people to take much more time off. A month off is preferable, but even this period may not be sufficient for some patients. Much depends on the type of work and the acceptability of a swollen appearance in the workplace. Those who work at home on their computer can often get back to work within 2 weeks, provided their eyesight is not blurry. There is also the element of unpredictability in the rate of healing and the possibility of complications to consider.


Q: What do I tell people?


A: It is usually easier for patients to be forthright about having the surgery and not try to think of some other reason for their time off. This avoids the anxiety of trying to hide something, although patients may not go into all the details about what they had done—“I had some laser work done, and my eyelids lifted at the same time.” Whether they mention the facelift, forehead lift, liposuction under the chin and chin implant is their business.